Forms & publications

If you are a biller or provider, visit our Billers and Providers forms library.

Adding a newborn in Healthplanfinder

Step by step instructions on how to apply for a newborn under Washington Apple Health (Medicaid) in Washington Healthplanfinder.

Publication

Administrative hearing request - DSHS Classic Medicaid

12-507

Complete this form to request an administrative hearing for DSHS Classic Medicaid.

Form

Administrative hearing request – HCA/HBE

12-511

Use this form to request a hearing before a judge. Mail this form within 90 calendar days of the date on eligibility notice you disagree with. You may be able to keep Apple Health coverage during the hearing process if you request a hearing in less than 10 days.

Form

Administrative hearing rights and deadlines

12-506

This document provides information on your rights and the deadlines associated with administrative hearings.

Form

Administrative hearing rights and deadlines - DSHS Classic Medicaid

12-508

This document provides information on your rights and the deadlines associated with administrative hearings. For DSHS Classic Medicaid clients.

Form

Administrative hearing withdrawal

12-512

A form for withdrawing a request for an administrative hearing.

Form

Adult dental coverage

22-811

This flyer provides an overview of dental services for adults, age 21 and older, covered by Washington Apple Health (Medicaid).

Publication

AEM fax cover sheet

Cover sheet to be used when faxing Alien Emergency Medical (AEM)-related materials to Health Care Authority.

Publication

Alien Emergency Medical (AEM) process

Shares the Alien Emergency Medical (AEM) process for individuals applying for all Washington Apple Health (Medicaid) AEM coverage.

Publication

Annual percent of eligible clients receiving dental services area map ages 20 and under

Report

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